RT Journal Article
SR Electronic
T1 Evaluation of a single centre stroke service reconfiguration – the impact of transition from a combined (acute and rehabilitation) stroke unit to a hyperacute model of stroke care
JF Future Hospital Journal
JO Future Hosp J
FD Royal College of Physicians
SP 99
OP 104
DO 10.7861/futurehosp.4-2-99
VO 4
IS 2
A1 Dipankar Dutta
A1 Kate Hellier
A1 Mudhar Obaid
A1 Arnold Deering
YR 2017
UL http://www.rcpjournals.org/content/4/2/99.abstract
AB We reorganised the combined (acute and rehab) stroke unit (SU) at Gloucestershire Royal Hospital into a hyperacute stroke unit (HASU) and a rehab SU where patients are moved after spending about 72 hours on HASU. Continuous monitoring of physiological variables was introduced and consultant job plans were reorganised to provide a HASU physician of the week model with enhanced 7-day senior presence along with redistribution of junior medical staff. Sentinel Stroke National Audit Programme (SSNAP) data for 14 months preceding the reorganisation (n=1,049) and 14 months after (n=974) were accessed for outcomes. More patients were admitted directly to the HASU with favourable reductions in time to computerised tomography scanning and stroke consultant assessment after the change. There were significant reductions in length of stay, pneumonia and urinary tract infections at 7 days and a favourable shift in modified Rankin scores (odds ratio 1.60, 95% confidence interval 1.36–1.89, p<0.001) on discharge from hospital.